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State Childrens Health

The State Children’s Health Insurance Program is a Federal funded and state administered program to provide health insurance coverage for children whose parents claim that they cannot afford to purchase health insurance coverage yet they make too much money to qualify for Medicaid.

Children's Health Insurance Programs: Health Care for ALL Children

One of the most compelling issues in society is that of health care and especially health care for children. There are millions of Americans that do not have health insurance. The single biggest cause of personal bankruptcy in the United States is medical bills. Many individuals shirk their responsibility to maintain adequate health insurance coverage for themselves and their family and in the end jeopardize their financial security while other individuals simply cannot afford to purchase health insurance and receive no assistance from Medicaid. Many claim that the issue has been getting worse in recent years and the government has had to intervene to form programs specifically designed to give children quality health care.

SCHIP and Covering Uninsured Children

One of the Government programs is the State Children’s Health Insurance Program (SCHIP). This program was created when in 1997 Ted Kennedy (Senator from Massachusetts) and Hillary Rodham Clinton (Former Senator of New York) got together and proposed the plan that finally was enacted through the Balanced Budget Act. This program required the Social Security Act to allocate at least 20 million expenses to cover uninsured children for ten years because the government saw that the number of uninsured children was rising. The act however, is solely designed for children of parents who earn too much money to be eligible for Medicaid (the government’s aid to low-income families) and still cannot afford to purchase private health insurance.

During Fiscal Year 2006 the SCHIP program is said to cover an estimated 6.9 million uninsured children across America (there is an approved plan in each state). This program is regulated by the Federal Government and it only requires that each state estimates the amount of money they are going to need for the year based on facts and figures about the number of uninsured children within the state lines. Because of this each state is required to determine the design of the program, the eligibility requirements, the benefit packages and the payment levels for coverage.

Some states are also starting to insure the parents (those who do not have health insurance via private companies of their insurer) of children receiving aid, uninsured pregnant women and other uninsured adults; however those states are running out of funds to operate with. It is important to note a proposal recently was passed on October 3, 2007 from Congress to the president stating that the SCHIP program had to be expanded from the regular 5 billion dollars used yearly to 35 billion over five years.

This however, didn’t get passed because the president decided to veto the bill and in turn changed the program of administrative rules which will make it more difficult for some children to qualify to the program. This bill would have given coverage to about 4 million more children by 2012. The Democratic leaders have said that they will try to vote in order to override the presidential veto, no later than October 18, 2007. Before they do that however, they are trying to see if there are any other solutions available to change the president’s mind.

How SCHIP Works

The State Children’s Health Insurance Program works just like Medicaid and Medicare do. They have directors in all 50 states including Hawaii and the District of Columbia that are in charge of making sure everything is running smoothly and the funds are being distributed correctly. This means that there is a partnership between the Federal Government and the States in which the states are regulated by the federal government and this in turn regulates the availability of funds and eligibility requirements.

Some states choose to run their SCHIP program apart from their Medicaid program. Some experts say that this is a smart choice depending on how they manage the money within the program. It’s a smart choice for states to establish different entities for both Medicaid/Medicare and SCHIP simply because if they do this they will be able to impose cost sharing, tailor benefit packages and have great flexibility on enrollment and eligibility decisions.

Usually what states do is decide on an income bracket that decides whether the family qualifies or not. This is based on the income tax return they file at the end of the year. Most states have the eligibility requirements based so that any child under the age of 19 living in a family whose income is below that of 36,200 (for a family of four) a year qualifies, but it's important to see the guidelines in each state because they can differ from what the regular bases are.

SCHIP covers children for immunizations, doctor visits, emergency room visits and hospitalizations. Also, recent studies have shown that children who were once a part of SCHIP and then they become in-eligible and leave SCHIP, are more likely to go without health insurance for a long period of time. This means that they will cost the state more money when they go to the emergency room or to the hospital than if they were covered.

SCHIP is one of the most important pieces of legislation passed to protect uninsured people since Medicaid and Medicare were created. If you want more information about this program then you can visit http://www.cms.hhs.gov/home/schip.asp or call your state’s SCHIP or Health Resources office. You will also find assistance and guidance on health insurance options for children in your particular state of residence by speaking with a knowledgeable independent health insurance agent.

Use our free quote finder to get started comparing quotes from the top health insurance companies offering coverage in your home zip code side by side. Get a free health insurance comparison now!

Every State has a Form of SCHIP

Every state has a Children’s Health Insurance Program (CHIP) that is subsidized by the federal government and is available to families with children under 19 who are not eligible for Medicaid due to income, but do not make enough to afford insurance on their own.  This health insurance program for children is provided under Title XXI of the Social Security Act through the Balanced Budget Act.  The goal is for every child in the United States to eventually have health insurance through specially designed children’s programs.

Eligibility for Children’s Health Insurance Programs

A family can make up to 200% of the federal poverty level before they are no longer eligible. That’s $34,100 for a family of four.   However, according to the National Academy for State Health Policy:

  • 13 states have set their eligibility above 200%

  • 8 states have set the eligibility below 200%

  • and the other 30 have set it right at 200%

The federal government has made the guidelines so broad for the Children’s Health Insurance Program that each state has the ability to customize the program, its design, eligibility rules, benefits packages, payment levels and administrative and operating procedures how they want it as long is it falls within federal guidelines.   

The major difference between the state Children’s Health Insurance Programs and Medicaid is that the state children’s health insurance programs are available only to children and adults who have special waivers.  According to the National Academy for State Health Policy,

  • 5 states currently cover childless adults

  • 6 states cover the parents of participating children

States are allowed to use money allotted to the state Children’s Health Insurance Program either through Medicaid expansion, state designated/private plans that are equivalent to either the Federal Employees Health Benefit Package, the state’s BlueCross/BlueShield plan or a combination of both Medicaid expansion and private health plans. 

Many states call their program by a different name than Children’s Health Insurance Program but it is all the same thing.  For example in Florida it is called KidCare and in Illinois it is All Kids.  Currently there are about 5.8 million children receiving health insurance coverage through state Children’s Health Insurance Programs.

Mandatory Coverage with Children’s Health Insurance Programs

All state Children’s Health Insurance Programs must cover:

  • Inpatient care

  • Outpatient care

  • Emergency room care (many states charge higher co-pays for improper use of the emergency room.  Use of the ER for things that could be better handled at a doctor’s office is one of the things that have contributed to the raising cost of health care.)

  • Well baby check ups

  • Well child check ups

  • Routine Immunizations

  • Laboratory and diagnostic testing

  • X-rays

  • Mental health and substance abuse programs although there is a limit on the number of visits that can be made each year.

  • Variations of maternity care for women through what is called Healthy Beginnings in nine different states.  2 states cover pregnant women while 7 others cover unborn children.

  • Dental Coverage

  • Hearing and eye exams

How to Apply for Children’s Health Insurance Programs

The application for applying for state Children’s Health Insurance Program is the exact same one used for applying for Medicaid.  You will need to provide evidence of:

  • Gross income including any child support

  • Expenses including child care and insurance 

  • Residency

  • Social security number(s) of the child/children you are seeking coverage for

The Children’ Health Insurance Program provides coverage to United States citizens, Legal Permanent Residents who are ineligible for Medicaid, and non-citizens who meet Alien Status requirements for Medicaid but are over the income and/or the resource limits for Medicaid.

It takes between four to six weeks for an application to be processed.  The application can be obtained on the Internet, through an independent insurance agent or through your local Department of Health and Human Services.

Find Children’s Health Insurance Programs

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